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In Reply: We agree with Dr Sierra-Johnson and colleagues that the modest number of CHD events in women in our investigation limits our ability to detect small differences in predictive performance of different lipids, and additional studies of larger samples are warranted. Regarding the criticism of the use of a composite CHD end point for risk prediction, this approach is consistent with our prior publications¹ and other risk prediction algorithms in the literature.² Furthermore, such an approach reflects clinical practice, in which the objective is to predict and prevent risk of all CHD events and not just one of its individual components. We did not analyze "hard" CHD events for this reason and because of a further reduction in statistical power to detect associations (due to a reduction in numbers of events), a concern also voiced by the writers.

We also share their concern regarding using the C-statistic as a . . . [Full Text of this Article]

Erik Ingelsson, MD, PhD; Michael J. Pencina, PhD; Ralph B. D’Agostino, PhD; Ramachandran S. Vasan, MD
vasan@bu.edu
The Framingham Study
Boston University School of Medicine
Framingham, Massachusetts